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Half-Way There!
HRSA UDS Sealants Measure Annual Update
Vy Nguyen, DDS, MPH, Dental Officer, Office of Quality Improvement, Bureau Primary Health Care, HRSAIrene V. Hilton, DDS, MPH, NNOHA Dental Consultant
Sherilee Callahan, Director of Oral Health, Regional Primary Care Network
The NNOHA ConferenceNovember 12, 2018
Objectives
• Understand the trends in national and state level results from three years of HRSA UDS dental sealants measure data
• Implement systems to consistently document and report sealant data, including exclusions, to improve the accuracy of your UDS sealant measure percentage
• Describe how one health center increased its UDS Sealants Measure percentage by implementing same-day-sealants
UDS Dental Sealants Measure UpdateNNOHA Annual Conference
November 12, 2018
Vy Nguyen, DDS, MPH, Dental OfficerOffice of Quality Improvement (OQI)Bureau of Primary Health Care (BPHC)Health Resources and Services Administration (HRSA)
Health Center Program Mission
Improve the health of the nation’s underserved communities and vulnerable populations by assuring access to comprehensive,
culturally competent, quality primary health care services
4
Strategic Goals
5
Increase Access to Care
Advance Quality and Impact
Optimize Operations
Health Center Program Mission: Improve the health of the nation’s underserved communities and vulnerable populations
Health Center Oral Health Programs
6
↑ dental patients by 8% to 6.1 million
↑ dental workforce by 10% with 4,882 dentists (FTE) and
2,498 dental hygienists (FTE)
Source: Uniform Data System, 2017
3.8 4 4.3 4.4 4.8 5.2 5.6 6.1
9.210
10.7 1111.9
13.214.4
15.7
0
2
4
6
8
10
12
14
16
18
Mill
ions
Health Center Dental Patients and Visits from 2010-2017
# of Patients # of Visits
UDS Dental Sealants Measure at Health Centers
7
Source: Uniform Data System 2015-2017 Table 6B† https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?BeginYear=2015
Provided dental sealants to 50.7% of children 6-9 years of age at elevated caries risk
Children 6-9 years of age at elevated caries risk that received dental sealants increased by 8.3
percentage points since 2015
42.4
48.7
50.7
38
40
42
44
46
48
50
52
UDS 2015 UDS 2016 UDS 2017
Dental Sealants Measure, %
NationalAverage †
2016 40.7%
Dental sealants measure introduced to the UDS in 2015 to capture the percentage of children, age 6-9 years of age, at moderate to high caries risk, who received a dental sealant on a first permanent molar during the measurement period.
UDS Dental Sealants Measure by State
8
Source: Uniform Data System 2015-2017 Table 6B
36 states, the District of Columbia, and Puerto Rico increased by at least 5 percentage points on the dental sealants measure from 2015 to 2017
Impact of BPHC Investments on the Dental Sealants Measure (1/4)Oral Health Service Expansion (OHSE) Supplemental Funding
9
Source: Uniform Data System 2015-2017 Table 6B† https://wwwn.cdc.gov/nchs/nhanes/continuousnhanes/default.aspx?BeginYear=2015
In 2016, 420 health centers were awarded $156 million through the OHSESupplemental Funding to increase access to oral health care services and improve oral health outcomes for Health Center Program patients.
48.0%
53.1%
0% 10% 20% 30% 40% 50% 60%
Dent
al S
eala
nts M
easu
re %
OHSENon-OHSE
Health centers that received OHSE funding had a higher average for the UDS dental sealants measure compared to health centers that did not receive OHSE funding.
Impact of BPHC Investments on the Dental Sealants Measure (2/4)Oral Health Service Expansion (OHSE) Supplemental Funding
10
From January to June 2018, HRSA in partnership with NNOHA hosted 6 Listening Sessions across the 10 HHS regions with a total of 162 health centers that received OHSE funding. One of the topics of discussion under quality improvement included challenges, opportunities, and successes with the UDS dental sealants measure.
Challenges and Areas of Opportunity Consistency among provider
documentation and coding Understanding and applying the
exclusions Lack of or inaccuracy of vendor
solutions
Strategies to Improve Measure Reporting Using “dummy” or “smart” codes Building templates to facilitate
access to “favorite” dummy codes for easier coding by providers and staff
Address coding issues at team and individual meetings with providers
Incentivize providers for correct coding
Impact of BPHC Investments on the Dental Sealants Measure (3/4)Health Center Controlled Networks (HCCNs)
11
Source: HCCN Impact Fact Sheet 2018
HCCNs support health centers in achieving meaningful use of ONC-certified EHRs, adopting technology-enabled quality improvement strategies, and engaging in HIE to strengthen the quality of care and improve patient outcomes.
Health centers in HCCNs are more likely to report on the universe of patients using their EHR. 83% of health centers in HCCNs versus 80% of health centers not in HCCNs reported on the universe of patients using their EHR for the dental sealants measure.
Impact of BPHC Investments on the Dental Sealants Measure (4/4)Oral Health T/TA National Cooperative Agreement (NCA)
12
Source: Uniform Data System 2017 Table 6B
As a NCA partner, the National Network for Oral Health Access (NNOHA) provides training and technical assistance to health centers to expand and integrate high quality oral health services and improve oral health outcomes.
From 2016 to 2017, NNOHA piloted a learning collaborative to train 5 health center oral health programs and subsequently expanded to 27 new health centers to:• Use the Model for
Improvement• Create the foundation for
monitoring, reporting, and improving on specific set of dashboard measures, including the UDS dental sealants measure
48.0%
53.3%
0% 10% 20% 30% 40% 50% 60%
Dent
al S
eala
nts M
easu
re %
Learning Collaborative Participants(32 Health Centers)
UDS 2017 National Average
Moving Forward … UDS 2018
13
Source: Uniform Data System 2017 Table 6B
Improve on the measure Integrate into clinical
workflows and quality improvement strategies
Train providers and staff Leverage EDRs/EHRs
and work with EDR/EHR vendors and in-house IT support
Engaging in learning opportunities through NCAs, PCAs, and HCCNs
Thank You!
Vy Nguyen, DDS, MPHDental Officer, Office of Quality ImprovementBureau of Primary Health Care (BPHC)Health Resources and Services Administration (HRSA)
(301) 827-9045
bphc.hrsa.gov
Sign up for the Primary Health Care Digest
14
Connect with HRSA
To learn more about our agency, visit
www.HRSA.gov
Sign up for the HRSA eNews
FOLLOW US:
15
Computing & Improvingthe UDS Sealants Measure
Irene V. Hilton, DDS, MPHNNOHA Dental Consultant
Dental Director, San Francisco Department of Public [email protected]
HRSA UDS Sealants Clinical Quality Measure
2015 2016 2017
2015 2016 2017
Potential to save 38 out of every 100 kids from a lifetime of restorations & repairs.
2016 JADA Guidelines
1. Sealants prevent cavities in permanent & primary molars
2. Sealants can prevent the progression of early non-cavitatedcarious lesions
3. Resin or glass ionomer
https://jada.ada.org/article/S0002-8177(16)30473-1/pdf
© 2015 Dental Quality Alliance
Measure Overview: Sealants 6-9 Years
DEN: Of dental patients, aged 6-9 years at elevated caries risk, of record in the practice in the reporting year, who needed a sealant in a
permanent first molar
NUM: How many received a sealant on a permanent first molar in the reporting year
Denominator Exclusions (subtract from denominator): All four molars are not candidates for sealants.
=
%
What if we don’t have an Electronic
Dental Record system?
• http://www.bphcdata.net/docs/uds_rep_instr.pdf
• Pg. 178- Sampling Methodology for Manual Chart Reviews
• 70 charts
© 2015 Dental Quality Alliance
Breaking Down the Denominator Criteria: Overview
DEN: Dental patients, aged 6-9 years at elevated caries risk, of record in the practice in the reporting year who needed a sealant in a
permanent first molar
6-9 years For CY 2018 UDS reporting: date of birth between January 1, 2009 – December 31, 2011
of record in the practice
had an oral assessment (CDT D0191) OR a comprehensive or periodic oral evaluation visit (CDT D0120, D0145, D0150, or D0180)
elevated caries risk
at moderate to high caries risk (CDT D0602 or D0603) based on caries risk assessment
Documenting CRA Electronically
What are Exclusions?
Documenting if a Child is Excluded from the Denominator
• Vendor solution- DEPENDENT ON CHARTING FOR TEETH #3, 14, 19, 30
• Use an EDR code- create a SMART code for electronic method
• Do not exclude- denominator will be bigger than it really is, so UDS % will be lower
Smart Codes
Visit Your EDR Vendor @ NNOHA
• Dentrix Enterprise
• ECW
• MediaDent
• QSI
Resources
• HRSA UDS Sealants Measure FAQ http://www.nnoha.org/resources/hrsa-sealant-measure-faqs-updated-4-2017hrsa-uds-sealant-measure-faq/
Webinar: HRSA UDS Sealants Measure Update
Friday December 7th, 201810amPST/11amMST/12noonCST/1pmEST
Top 10 Ways to Increase Your
UDS Sealants Measure %
#10 Increase Demand
#9Increasetreatment planning
#8 Equipment
#7 Materials
• GI or Resin?
• Moist field• Partially erupted• Self-cured
#6 RDH Place Sealants w/o Dentist
http://www.oralhealthworkforce.org/wp-content/uploads/2017/07/Single-Page-Layout-Final_July_2017.pdfhttp://www.adha.org/resources-docs/7511_Permitted_Services_Supervision_Levels_by_State.pdf
#5 Expanded Function RDA Place Sealant
States where practice act allow RDA (EF/certificate) to place sealants under direct supervision
#4 Patient Protocols- Flow Charts for Sealants
#3 Sealant Placement > Routine Restorative
• First Visit: Exam, x-rays, P&F
• Second visit: K/L
• Third visit: T/S
• Fourth visit: Bilateral Spacer
• Fifth visit: Re-care (because six months have now passed and we’re due again)
• Sixth visit: Seal Teeth #19, 30? Oh wait, now they have cavities…
• Exam/First visit:• Self Management
Goals• Seal Teeth #19, 30• SDF? P&F?
• Second visit:• Check SMGs• Extract Tooth #K,
T?
• Third visit• Glass ionomer
restoration # L & S or let exfoliate
#2 Sealant Only Columns/Days
• Can schedule where most efficient
• Economies of scale• Allows support staff to
work at top of scope• Frees provider time for
surgical procedures
#1 SAME DAY SEALANTS
#1 – Same Day Sealants
• Ready to go sealant kits• Daily huddles to ID patients• Staff performing top of license• Establish protocols & workflow• Use previous ideas to help with efficiency
Central and Finger Lakes regions of New
York State (NYS)5 locations geographically diverseUrban and rural sites Primary medical, behavioral health, dental &
adding pre-natalPortable school-based preventative dental
program in 141 schools
About RPHN
We take quality very seriously and are
always looking for ways to increase patient satisfaction and improved health outcomes.
We have several quality incentive measures that our providers must meet, both in medical and dental.
Quality of Care
Caries Risk Assessment (CRA) on all patients Blood Pressure on New patients 12+ years old Blood Pressure on all Extraction patients Smoking Cessation on Smokers 12+ years old And recently added: Ages 6-9 Sealant Measure
Current Quality Measures
We utilized several PDSA’s
simultaneously to increase number of sealants for children ages 6-9 & 10-14Main PDSA focused on
implementing “Same Day Sealants”
Plan Do Study Act Model of Improvement (PDSA)
Initial data (9 months prior to PDSA’s)
6-9 year olds- 19%
0
20
40
60
80
100
Jan-
17
Apr
-17
Jul-1
7
Oct
-17
Jan-
18
Apr
-18
Jul-1
8
Oct
-18
Jan-
19
Apr
-19
Jul-1
9
Oct
-19
per c
ent
10-14 year olds- 14.7%
0
20
40
60
80
100
per c
ent
Senior Management Buy-In:
Will revenue be lost? Provider Resistance:
Many of our providers were resistant to doing this. As an FQHC we all know how booked we can be and the thought of adding another thing to the appointment was overwhelming for some providers. Are we going to get more time? A new work flow too…ugh!
Provider Confusion: Is this the same as the UDS Sealant Measure? Am I supposed to do this at all appointments? What codes should I be using?
Data Collection: Initial data was not what we had expected so we planned on making
adjustments to provide more accurate results.
Barriers to doing Same Day Sealants
Current Sealant Workflow
We had to change the way our providers thought
about the need for sealants as a disease management strategy.
Providers needed more training to increase their confidence in documenting correctly.
Major Lessons Learned from PDSA Cycles
Some Change after 2 PDSA Cycles
All RPCN- From 19% to 27%
0
20
40
60
80
100
Jan-
17
Apr
-17
Jul-1
7
Oct
-17
Jan-
18
Apr
-18
Jul-1
8
Oct
-18
Jan-
19
Apr
-19
Jul-1
9
Oct
-19
per c
ent
4. Sealants (6-9 Year Olds)
All RPCN-From 14.7% to 25%
0
20
40
60
80
100
Jan-
17
Apr
-17
Jul-1
7
Oct
-17
Jan-
18
Apr
-18
Jul-1
8
Oct
-18
Jan-
19
Apr
-19
Jul-1
9
Oct
-19
per c
ent
5. Sealants (10-14 Year Olds)
1st site data after 2 cycles
January-2018
Codes
Dental Visits
Dental Vists and N2223,D1351, 1351D
# Unique Patients 43 19
Percentages 44.19%
February-2018
Codes
Dental Visits
Dental Vists and N2223,D1351, 1351D
# Unique Patients 32 21
Percentages 65.63%
6-9 year olds
2nd Site
1st month March-2018
Codes
Dental Visits
Dental Vists and N2223,D1351, 1351D
# Unique Patients 16 2
Percentages 12.50%
Following MonthApril-2018
Codes
Dental Visits
Dental Vists and N2223,D1351, 1351D
# Unique Patients 11 10
Percentages 90.91%
3rd Site
Sealants 6-9Initial Month
Codes
Dental Visits
Dental Vists and N2223,D1351, 1351D
# Unique Patients 60 9
Percentages 15.00%
Sealants 6-9Following Month
Codes
Dental Visits
Dental Vists and N2223,D1351, 1351D
# Unique Patients 48 15
Percentages 31.25%
Where We Are Now
Sealants 6-9: 49%
0
20
40
60
80
100
Jan-
17
Apr
-17
Jul-1
7
Oct
-17
Jan-
18
Apr
-18
Jul-1
8
Oct
-18
Jan-
19
Apr
-19
Jul-1
9
Oct
-19
per c
ent
Sealants 10-14: 52%
0
20
40
60
80
100
Jan-
17
Apr
-17
Jul-1
7
Oct
-17
Jan-
18
Apr
-18
Jul-1
8
Oct
-18
Jan-
19
Apr
-19
Jul-1
9
Oct
-19
per c
ent
Compared to our initial data we have seen an
improvement through out the organization.
6-9 yr. went from 27% to 49%
10-14 yr. went from 25% to 52%
Have We Been Successful?
RPCN Overall
461
1254
36%
Has doing same day sealants helped toimprove your organizations UDS
Measure?
2016 2017 Jan. - Sept.2018
RPCN Overall
384
1155
33%
RPCN Overall
359
694
52%
Healthier Patients = Success
Thank You & Questions:
This project is supported by the Health Resources and Services Administration (HRSA)
of the U.S. Department of Health and Human Services (HHS) as part of an award totaling
$500,000 under grant number U30SC29051 with 0% percentage financed with non-governmental sources. The contents are those of the author(s)
and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information,
please visit HRSA.gov.